Pediatrics Flashcards
Ductus venosus
Umbilical vein to IVC (bypassing liver)
Ductus Arterios
Aorta to pulmonary artery
Umbilical arteries (2)-
carries deoxygenated blood from fetus back to mother
Umbilical vein
carries oxygenated blood
CO dependent on HR
does not tolerate bradycardia
SV fixed
always have glyco/atropine
The baroreceptor reflex is not completely developed
Limiting ability to compensate for hypotension with reflex tachycardia
Autonomic innervation of the neonatal heart is predominately controlled by the
parasympathetic nervous system
Bradycardia with minor interventions (suctioning/DL)
total body water of preterm infant
80%
total body water of term infant
70
total body water of 6m-1y
60
VOD
Vd = Dose / plasma concentration of drug
Loading dose =
Vd x ( desired plasma concentration/bioavailability)
Acidic drugs are favortable absorbed where?
stomach (Non-ionized)
Basic drugs are best absorbed where?
alkaline intestines
(most oral drugs)
Slower in neonates and young children-delayed gastric emptying
Time in weeks between the first day of the last menstrual period and the day of delivery (weeks).
Gestational age
Time that has elapsed since birth (days, weeks, months or years)
Chronological Age
Gestational age + chronological age (weeks)
Post Menstrual Age
At what age does a baby need to stay overnight for apnea monitoring?
60 weeks post gestational age or PMA
Chronological age is reduced by the number of weeks born before 40 weeks of gestation (weeks, months).
Corrected Age
dictates mile stones
pvr in utero
elevated
Diverts a majority of RV output to the descending aorta via ductus arteriosus.
describe Transitional Circulation
Lungs: fluid is replaced by air (raising alveolar O2 tension) and fluid is resorbed
↓ PVR
Hypoxic vasoconstriction in lungs reverses
↑ flow of blood in lungs → Path of least resistance
↑ blood return to LA (↑ pressure)-PFO closes (closes pop off)
↑ flow out LVOT, DA senses ↑ pO2, PGE from placenta ↓ & DA closes
PGE keeps DA open during transposition, HLHS
Persistent Pulmonary Hypertension of the Newborn
PDO / PDA might not close because of high right-sided pressure
Rapid desaturation: FiO2 won’t help → Phenylephrine and Nitric Oxide
Managing PPHN
O2, correct acidosis, normothermia, nitric oxide, surfactant, HFV, remodulin, sildenafil, milrinone, bosentan
Can peds patients adjust their SV?
no. SV fixed, CO is dependent on HR
CO = HR x SV
baroreceptor is not developed
Limiting ability to compensate for hypotension with reflex tachycardia
fetal hemoglobin causes a what shift?
left (love) 19 vs 27
when is physiologic nadir of hgb
3-4 months
what Clotting factors are 20-50% of adult levels?
2, 7, 9, 10
neonatal airway caviats
epiglottis longer/ narrower
Larynx anterior/cephalad/smaller
shorter neck
tongue/adenoids larger
telescopic subglottic area
FRC in neonate
Lower
diaphram in neonate
flat instead of dome
metabolic rate / O2 consumption in neonate
increased
Hypoglycemia can cause
apnea
hypotension
bradycardia
convulsions
brain injury
Exposure to noxious stimuli/pain with inadequate or absent pain control can have physiologic consequences
→ Intraventicular Hemorrhage & PHTN
Lack of development of inhibitory tracts may increase the intensity and duration of painful stimuli
when do fontanelles close
Anterior fontanelle closes at 2 years
Posterior fontanelle closes at 4 months
most common heat loss
Radiant (majority): loss to environment (air)
cover head
Neonate lacks ability to regulate body temperature due to
Large surface area
Lack of SQ tissues
Inability to shiver
where to maintain sats to prevent ROP?
O2 sats- 92-98%
atropine increases IOP –> use glyco
All infants less than how many PCA should be monitored
<62 weeks PCA
coarctation high BP
Coarc: high BP on L upper extremity
NPO status
Current recommendations from ASA
2: clear liquids
4: breast milk
6: formula, fortified breast milk
8: solids
Size of ETT
2 & up: Uncuffed
(age in years/4) + 4
or
(Age +16)/4
Cuffed to cuffed drop ½ size
Leak desirable between 15-25 cm H2O
Depth of ETT:
3x ID of ETT
Nasal + 1-1.5cm
Uncuffed ETT have double black line (place at VC)
preterm baby ETT and Miller
ETT 2.0 - 3.0
Miller 0
full term ETT
ETT 3-3.5
Miller 1 - WIS 1.5
3mo - 1 year ETT
ETT 4.0
Miller 1 - WIS 1.5 or
WIS 1.5 - Miller 2
po dose of midazolam
Midazolam (0.25-1 mg/kg PO)
IM & PO dose ketamine
Ketamine (6 mg/kg PO)
IN dose dexmede
Dexmedetomidine (2mcg/kg IN)
dose of succinylcholine
2mg/kg
Atropine
0.02 mg/kg
epi dose
0.01mg/kg
propofol induction dose
2.5-3.5 mg/kg
why are peds sensitive to NDMB?
Low levels of Ach at the motor nerves but counterbalanced by increased VOD.
Increased dosing of Sux d/t large VOD.
Intravenous Induction indications
full stomach
hx GERD
disease state (illness)
what is emla ?
2.5% lido/prilocaine
apply 30-60 m
emla risk?
methemoglobinemia (rare side effect of prilocaine toxicity)
Methemoglobinemia review
S/S: hypoxia, cyanosis, tachycardia, tachypnea,
Benzocaine >300mg, prilocaine, cetacaine, ELMA
decreased O2 carrying capacity by changing the binding of O2 to hemoglobin
Left shift
Pulse ox will be 85% with a normal PaO2 75-100
> 70: dialysis and exchange transfusion
Methylene Blue: 1-2 mg/kg over 5-10min
MAC _____ in neonatal period & ____ in infants (1-6m)
lower; highest
Adverse respiratory events with Iso/Des:
breath holding
laryngospasm
coughing
increased secretions
Reversal
0.05 mg/kg of Neostigmine (same as adults)
0.02 mg/kg Atropine
0.01 mg/kg Glyco
BRIDION® (sugammadex) is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults and pediatric patients aged
2 years and older undergoing surgery
sugammadex dose in peds
2 mg/kg
intentionally avoided in males and teenagers
Laryngospasm
PPV
Succ (4mg/kg) and Atropine IM ( 0.02 mg/kg, with a maximum dose of 0.5 mg)
